School-based Health Clinics: Effects on Youth and Young Adult Sexual Behavior

学校健康诊所：对青少年和青少年性行为的影响

• 批准号: 8503905
• 负责人: MELINA BERSAMIN
• 金额: $ 59.68万
• 依托单位: PACIFIC INSTITUTE FOR RES AND EVALUATION
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-22 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8503905
• 关键词: Address; Adolescence; Adolescent; Age; Attitude; Behavior; Birth Rate; Catchment Area; Characteristics; Clinic; Cognitive; Communities; Confidentiality; Contraceptive Usage; Contraceptive methods; Counseling; Data; Decision Making; Development; Education; Environment; Exposure to; Family Planning; Female; Goals; Health; Health Care Seeking Behavior; Health Services; Health behavior; Healthcare; Home environment; Hour; Institution; Intervention; Interview; Knowledge; Life; Long-Term Effects; Longitudinal Studies; Measures; Mediating; Mediator of activation protein; Medical; Modeling; Neighborhoods; Online Systems; Outcome; Patient Self-Report; Planned Pregnancy; Policies; Pregnancy; Pregnancy Rate; Preventive; Problem behavior; Procedures; Provider; Recruitment Activity; Reproduction; Reproductive Behavior; Reproductive Health; Reproductive Health Services; Research; Resources; Respondent; Risk; Risk Behaviors; Role; Sampling; Schools; Self Efficacy; Services; Sex Behavior; Site; Students; Surveys; Teenagers; Telephone; Time; Unplanned pregnancy; Youth; aged; base; comparison group; cost; cultural competence; design; feeding; high risk; high school; meetings; operation; prevent; prospective; public health relevance; reproductive; satisfaction; sex; sex risk; theories; unintended pregnancy; young adult; young woman

DESCRIPTION (provided by applicant): Interventions targeting structural or contextual variables have been associated with significant reductions in problem behaviors (e.g., Celentano et al., 1998); however, the preventive value of such approaches has not been studied extensively with respect to unintended pregnancy among youth, and across time to young adulthood. School-based health clinics with a family planning component (SBHC-FPCs) may promote the use of family planning services as they (1) are embedded within schools, the only public institution with the capacity to reach a majority of youth (Satcher, 1995); (2) are designed to reduce barriers associated with accessing reproductive services (e.g., finances, confidentiality concerns; Kirby, 2002); and (3) directly or indirectly expose youth to family planning resources and services that exist in their community. Research on SBHC-FPCs and reproductive behaviors has been mixed, largely due to methodological weaknesses (Kirby, 2002). The current study aims to examine whether the presence of SBHC-FPCs in high school is associated with positive short- term effects in adolescence on (A) mediating cognitive variables (e.g., reproductive attitudes, perceived sexual norms), (B) perceived availability and use of family planning services, and (C) pregnancy risk behaviors including age of sexual initiation, number of partners, and contraceptive use. We will also investigate whether students who have access to more comprehensive SBHC-FPC services in high school have (A) greater perceived availability and use of family planning services, and (B) engage in fewer pregnancy risk behaviors including delayed age of sexual initiation, fewer number of partners, and effective contraceptive use, compared to those with less comprehensive services both in high school and later. In addition, by following adolescents as they transition into young adulthood we will be able to examine if lagged and/or carry-over effects of exposure to SBHC-FPCs persist into young adulthood and assess whether family planning behaviors and unplanned pregnancy rates differ among those who attended schools with an SBHC-FPC and those who did not. A secondary goal is to assess the role of clinic characteristics (e.g. staffing, hours, perceived cultural competence of staff) on outcome variables such as family planning self-efficacy, reproductive health seeking behaviors, and family planning behaviors and intentions. Our proposed study goes beyond earlier research by 1) developing a rigorous school matching procedure thus addressing issues associated with lack of adequate comparison schools; 2) recruiting a large sample to detect small effects; 3) using a list-assisted sample to encompass both clinic users and non-users; and 4) measuring use of all family planning providers, which will allow us to capture substitution effects. Findings will increase understanding of the effects f SBHC-FPCs on reproductive health-seeking behavior and effective SBHC-FPC services. Additionally, results will provide important data that can be used in efforts to help better understand how access to medical services more generally influences health behaviors.

描述（由申请人提供）：针对结构或背景变量的干预措施与问题行为的显著减少有关（例如，Celentano等人，1998年）;然而，这些方法在青年人意外怀孕方面的预防价值，以及在整个成年期内的预防价值，尚未得到广泛研究。具有计划生育内容的学校保健诊所可以促进计划生育服务的使用，因为它们（1）植根于学校，学校是唯一有能力接触大多数青年的公共机构（Satcher，1995年）;（2）旨在 减少与获得生殖服务有关的障碍（例如，（3）直接或间接地使青年接触其社区现有的计划生育资源和服务。关于SBHC-FPC和生殖行为的研究好坏参半，主要是由于方法上的缺陷（Kirby，2002年）。目前的研究旨在检查高中SBHC-FPC的存在是否与青春期对（A）中介认知变量（例如，生殖态度，感知的性规范），（B）感知的可用性和计划生育服务的使用，和（C）怀孕风险行为，包括性开始年龄，伴侣数量和避孕药具的使用。我们还将调查在高中获得更全面的SBHC-FPC服务的学生是否（A）更好地感知计划生育服务的可用性和使用，以及（B）与那些在高中及以后获得较不全面服务的学生相比，参与较少的怀孕风险行为，包括延迟性开始年龄，伴侣数量较少，有效避孕。此外，通过跟踪青少年过渡到青年期，我们将能够检查暴露于SBHC-FPC的滞后和/或遗留影响是否持续到青年期，并评估计划生育行为和计划外怀孕率是否在那些参加SBHC-FPC学校的人和那些没有的人之间存在差异。第二个目标是评估诊所特征（如人员配备，工作时间，员工的感知文化能力）对结果变量的作用，如计划生育自我效能，生殖健康寻求行为，计划生育行为和意图。我们提出的研究超越了早期的研究：1）制定严格的学校匹配程序，从而解决与缺乏足够的比较学校相关的问题; 2）招募大样本来检测小的影响; 3）使用列表辅助样本，包括诊所用户和非用户;和4）测量所有计划生育提供者的使用，这将使我们能够捕获替代效应。研究结果将增加对SBHC-FPC对生殖健康寻求行为和有效SBHC-FPC服务的影响的理解。此外，研究结果将提供重要的数据，可用于帮助更好地了解获得医疗服务如何更普遍地影响健康行为。